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Path(ology) to radiation

Was anyone else expecting my oncologist(s) to declare me “cancer free”? Yeah, me too, but I guess it doesn’t work that way. The pathology report from my surgery showed that Chemo did reduce the size of my tumor by over half and it was removed with clear margins (all cancer cleared from original site and surrounding tissue)! So, why aren't we celebrating yet?

My surgeon also removed 3 lymph nodes, including the sentinel (boss node) and sent them for testing. Well, sad panda, cancer was found in one of them. Not much cancer, but still cancer. Chemo had eliminated a lot of it, but had not killed it entirely. Hard to believe anything can survive chemo, but it's scary as hell to know that some cancer can.

So, basically, the pathology report wasn't great, but at least we know that all the cancer is gone, right?  We got the tumor and the diseased lymph node, so we got the cancer all out, right? I'm cancer free!? This is what I am waiting to hear from the doctors - but the best I could get from the oncologists was "most likely the cancer is out of your body". MOST LIKELY?!

What do I do now? I'm going to do radiation treatment. While I most likely don't have cancer anymore, but just in case any cells went rogue and are swimming around somewhere thinking about cannonballing up my life again, we're gonna zap them.

I had already mentally prepared for this, as we knew the lymph node was still positive before surgery, so I don't really have many feelings about it. Basically, it sucks, but this whole damn thing sucks, so let's just keep going and see this thing through to the end.

I'm nervous, of course, about side effects - both short term and long term. I'm worried about small stuff, like what radiation will do to my skin and how it will impact my reconstruction. How will I handle the logistics of daily treatment with a 2 year old in tow? I'm scared, but like all other aspects of this process, I have to do every possible thing I can to stay here for my family. If there's a chance radiation will kill any remaining cancer cells and lessen my chances of a recurrence, then I have to take it.

I won't be able to get any additional fills to my expanders once radiation begins, so we only have 3 weeks to do 6 weeks worth of skin stretching. I had my first fill this week and it was crazy, I'll have to  do an entire post on the process, because, wow. But, I'll leave you with this - I sat there, while they stuck a needle in my "boobs" and pumped them up, like balloons, with saline. I literally saw them inflate in front of my eyes, it was surreal. They will pump me up a bit more each week until I start radiation. Then we wait and see how my skin reacts.

In the meantime, I'm noticing the lingering effects from the chemo less and less each day. My nails are dead, but they haven’t fallen off and...
See that beautiful soft pink?! There’s new growth! 
And yesterday I noticed I had LOTS of hair under my arms, now if only I could lift my arms up high enough or long enough to shave. I’ll spare you the photo on that on.

So, basically, there's growth happening over here and I'm most likely, cancer free. Let's do some radiation to keep it that way. Suck it cancer.

She's so Flat

I did it. I walked into that hospital because I had to. Once I walked through those doors, the rest was up to my team (I may not ever have the words to express my gratitude for those individuals). My surgeons, doctors, nurses, all of them, made it possible for me to say that I am alive!

The pain has been manageable thanks to strong pharmaceuticals. I stopped taking the opiate meds about 3 days post-op because, omg, they are the worst. Itchiness all over, all the time and it took DAYS to poop, after much abdominal distress! Nope, I'll just rely on Ibuprofen. 

It hasn't been easy though, I actually had to have a followup surgery yesterday (11 days post-op) because of a slight complication. At my first appointment with my plastic surgeon after surgery, they took the bandages off and noticed right away that I had developed some skin necrosis. Don't google it, it's gross, trust me. It's simply dead skin. Some of my skin died because, at some point during the initial surgery, the network of blood vessels that supply blood to the tissue were damaged. Basically, it lost it's connection to the blood supply and died. So, my plastic surgeon had to get me back in the O.R. and remove the dead skin/tissue. 

Other than the pain and discomfort, the worst part of recovery has been the J.P. Drains. Double mastectomy with expander placement, means two drains on each side. They removed one from each side at that first post-op appointment. So, now, I have one on each side. That's better, but I still can't wait to get them out. I'm assuming I'll have them longer since I had to have that second surgery. 

What else, my range of motion with my arms is non existent. I'm trying to T-Rex everything, but that natural instinct is to reach out, don't do it. I reached up and grabbed something and needed to use the opiate pain meds to squash the pain. And for some reason, I keep injuring my left arm in bed. I think I'm using it to push up or move positions, I wake up screaming in pain from arm pain. It's not my chest, that's primarily numb, but my armpits and arm muscles are donezo. 

Boob Voyage

It's the eve of my double mastectomy and I'm having a lot of feelings. Mostly anxiety, but some definite sadness too.

Don't get me wrong, I understand the importance of this surgery in my treatment plan, I know it has to happen. Since the Chemo didn't kill my tumor, this surgery is even more crucial than ever. But it's still hard, emotionally.

I'm anxious because it's a major surgery and things can go wrong. I'm scared I'll still have cancer when they get the pathology report back. So basically, I'm scared to have the surgery, but I'm scared I'll die if I don't. You know, the normal things to be anxious about.

But lets get down to it...

Boobs. They're just boobs, right? I mean, I don't need them. I was never particularly attached to them, probably because I developed them right when I was expecting them and never had to want for them. They aren't huge but they aren't small, so they weren't something I ever spent any time focusing on. I had friends that wished for bigger ones. Or smaller ones. I remember Rudy Huxtable ordering magic cream to make her boobs come in, which obviously didn't work. I listened to my friends and I watched the very special tv episodes, but boobs weren't my issue. I was always much more concerned with how fat I was. My boobs were just boobs. BUT THEY WERE BOOBS, if I had no boobs it would've been a different story altogether.

But now, those boobs are infected, diseased and they're trying to kill me, so why am I so emotional about losing them?

I suppose a lot of it is the fact that at this point, nearly 8 months since my diagnosis, I'm feeling pretty low, self confidence wise. It feels a little like with each new phase of treatment a little piece of my femininity is taken away...

First, I lost the hair on my head. Being a bald woman has been difficult. I've yet to work up the courage to go commando (no head covering) in public.

Then I lost my eyelashes and my skin turned so dry it flakes off. So I can't even put makeup on to try and look better.

A month into chemo, my periods stopped. That was a temporary benefit, I thought. Then my Oncologist told me the next step was a monthly shot, Zoladex, to shut down ovary function, forever, so that I'd be forced into menopause.

And now, they're amputating my breasts. I know I'll get reconstructed boobies, but with months of fills (with the temporary expanders to stretch the skin) and possible radiation looming, it will be a long time before I have anything near normal looking boobies.

I know, I know. Who cares what they look like, I'll be alive. I know! Stop lecturing me.

So that's where I'm at. I'm thankful I have this way to prolong my life, but I'm scared to have it done. I'm super pissed my boobs betrayed me, but I'm still sad to see them go.


Chemo Response and Next Steps

After Chemo, it's standard procedure to send you for some scans to access how well your cancer responded to the treatments. Which meant last week I went in for a few tests.

First up was another mammogram. Again, I just want to reiterate for the ladies in the back, mammograms are NO BIG DEAL, so check your boobies! My boob was smushed for 20 seconds or so and then it's over.

Next, we had another breast ultrasound and that of course, everyone knows, isn't painful or invasive. It's the same as an ultrasound you would receive while pregnant, except they are looking at your breast, not your uterus. This particular ultrasound was LONG. I'd say she was swabbing that wand thingy around on my boob for at least a half hour.

Once they were done, they were immediately sent to the radiologist that was in that day. Rather than sending me home, they had me wait for my results before I could go. I had an immediate flashback to my initial breast ultrasound back in November, I began to sweat and I knew something wasn't right. Just. Like. November.

So, I waited. For 23 LONG minutes, I waited. Then, the technician (slash nurse, I'm not 100% sure of her title) came back in and said the radiologist had reviewed the images and the official response to chemo was "very minimal".  I asked her what that meant and of course, she said my Doctors would explain further but that my tumor had not decreased in size much (seriously, hardly at all). She didn't know anything more, so off I went.

Since then, I've learned a bit more, but still not much. Apparently, some tumors simply don't respond to Chemo. Especially, hormone positive ones, like mine. Initially, when I was on my 4 rounds of AC Chemo, I felt the tumor softening and shrinking. But, it never got any smaller once I started the Taxol treatments. I remember asking my Oncologist "that doesn't mean it's not working, right?!" at an appointment. He assured me that it was still working, even if I couldn't feel it shrinking.

Now, of course, fast forward 12 weeks and I get confirmation that it really didn't shrink much. In fact, the measurements went from 4.7cm to 4.6cm!!! That's it. After 16 rounds, nearly 6 fucking months, and my tumor was still the same size. I felt extremely defeated and like I had just wasted the last few months feeling awful, missing out on countless moments with my family, all for what? Nothing?! It couldn't have all been for nothing, could it?

In all honesty, I don't know, but I do know, though, that for the first time since I was diagnosed,  I had a real fear that I actually might not beat this thing. And so I got in my car and I cried and cried. Then I put on my brave face, went home and hugged my kids.

Since then, my doctors have tried to calm my fears and assure me that they will still be able to get the tumor out of me and they will remove all the lymph nodes where the cancer may have spread. When we started this course of treatment earlier this year, the goal wasn't to be cancer free at the end of Chemo (I guess my doctors knew better but I was idealistically optimistic), it was to, hopefully, rid the cancer from the nearby node and prevent the cancer from spreading any further in my body. Which we don't know if we were successful in doing and won't know until surgery.

So, here we are. I've made my decision - double mastectomy - and we have a date. July 22nd. Let's do this shit!

My breast surgeon ordered an MRI, just to see a bigger/clearer picture of my response to chemo. The results were much more positive. It looks as though, the active cancer portion of my tumor has shrunk nearly half, the remaining portion is scar tissue. The lymph node(s) are showing as still enlarged, but not as enlarged as before (they aren't testing them for active cancer until surgery though).